Category Archives: Patients

Real Friends

William Tuke

William Tuke and Philippe Pinel are generally credited with revolutionizing the care of the insane in England and France, respectively. These men substituted compassionate care for patients (at the York Retreat and the Bicêtre) for the typical imprisonment and harsh punishment the insane received before that time. But . . .

Before either of these men were even born, the Religious Society of Friends in Philadelphia were concerned about the sick and insane living in the new continent of America. Around 1709, they expressed this concern in one of their monthly meetings, and took steps to establish the Pennsylvania Hospital for both these groups in 1751, and later the Friends’ Asylum for the Relief of Persons Deprived of the Use of Their Reason solely for the insane in 1813. The asylum (which actually began to receive patients in 1817) had as one of its stated goals, to be a place where “the insane might see that they were regarded as men and brethren.” The York Retreat predated the Friends’ Asylum by a few years, but the idea for the American asylum had come much earlier and was probably delayed for many reasons, possibly including the political unrest going on in the colonies.

Friends’ Asylum for the Insane

When the asylum first opened, it was only for fellow Friends, but in 1834 the religious affiliation was dropped and the institution opened its doors to all patients. From its beginning, all efforts were directed toward helping patients without resorting to restraints or cruelty. The annual report from 1853 states that “a chain was never used for the confinement of a patient.” The founders also wrote into the rules the injunction: “Come what may, the law of kindness must at all times prevail.”

Friends’ Asylum History

The Asylum was a far cry from the conditions Dorothea Dix met in Little Compton, Rhode Island (see last post), which were barbaric to the point of torture.

Why Asylums?

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New Pennsylvania Hospital for the Insane Under Construction, circa 1859, courtesy Library of Congress

Just the word “asylum” conjures up negative associations for most people–we have learned so much about the conditions and abuses in these institutions that it is hard to believe anyone thought they could be a good idea. We may understand that this deterioration was never anticipated by the original asylum advocates, but we still ask the question: couldn’t they have guessed what would happen?

Perhaps not. Here is a description of a lunatic’s dwelling in Little Compton, Rhode Island circa 1845: “The place, when closed, had no source of light or of ventilation. It was about seven feet by seven, and six and a half high. All, even the roof, was of stone. An iron frame interlaced with rope, was the sole furniture. The place was filthy, damp, and noisome.

“. . . –there he stood [the insane man] near the door . . . his tangled hair fell about his shoulders; his bare feet pressed the filthy, wet stone floor; he was emaciated to a shadow. . . . In moving a little forward I struck against something which returned a sharp metallic sound; it was a length of ox-chain, connected to an iron ring which encircled a leg of the insane man.”

Seated Portrait of Dorothea Dix, circa 1849

The writer, Dorothea Dix, discovered that the man had been in this little cell for three years, with no heat in the winter. Before that, he was kept in a cage. Dix’s outrage and compassion for the unfortunate men and women held in these conditions spurred her life’s work of urging states to build asylums with decent conditions and amenities.

One Result of Dix’s Concern Was the Butler Hospital

When Dix saw the day-and-night difference in new asylums and the type of private care she described above, she undoubtedly believed that conditions could never be so bad in an institution as they had been under the haphazard system that spurred her reforms. And though asylum conditions did go downhill, they were never tolerated by society at large the way earlier abuses had been.

Nerve-Waste and Insanity

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Dr. Edwin Pratt

Medicine in the 1800s was not always founded on firm data; it often based cures solely on (what someone thought) were reasonable assumptions. Dr. Edwin Hartley Pratt was a homeopathic physician who eventually wrote in his 1891 book, The Philosophy of Orificial Surgery, that there was one predisposing cause for all forms of chronic diseases: “and that is a nerve-waste occasioned by orificial irritation at the lower openings of the body.”

In the September, 1893 issue of a journal called The New Way, an unattributed article presented an example of “orificial philosophy.” The author referred to an article in the Journal of Nervous and Mental Disease which discussed the abatement of insanity in cholera patients. Sixty patients were sickened by the disease at the Bonneval Asylum in France. During its peak manifestation in their bodies, “maniacs” were relieved of all symptoms of insanity, though they gradually returned as the victims got well. Melancholics were also helped, and patients who were melancholic or only slightly insane seemed to recover their sanity permanently.

Pratt’s Book on the Treatment of Chronic Diseases

Though the Journal of Nervous and Mental Disease didn’t speculate about why cholera helped relieve insanity, The New Way did. “Cholera is a disease of the bowels, and results in their violent and complete evacuation and dilatation of the anal sphincter. Following this comes a compete relaxation of the whole muscular system.”

This gave the brain relief “and reason was restored while the condition lasted,” the author continued. “But as soon as the patient recovered from the cholera the relaxed condition of the muscular system disappeared and the sphincter became tight again.”

One of Pratt’s Sanatoriums

The result? The inhibition of the sympathetic nervous system, “deranged circulation and a return of insanity.” The anonymous author then wrapped up his case with the declaration that “seven-tenths of the cases of insanity, irritation and derangement will be found at the outlets of the body.”*

September 1893, Vol 1, No. 5, p. 125

Strong Ties

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New Jersey State Hospital for the Insane

Sudden tragedies sometimes created mental problems that eventually sent victims to an insane asylum; today we would probably consider these cases examples of severe depression or PTSD. Researchers occasionally come across accounts that describe a woman driven mad by the loss of a child or husband, but not so frequently about men driven mad for the same reasons. However, a double tragedy sent one prosperous businessman to an asylum . . . to join his son.

Sometime in the mid to late 1880s, Daniel Henry’s young son got lost in the woods south of Trenton, New Jersey. Thanks to a prolonged search, the boy was eventually found a week later. Unfortunately, though, his suffering and fear had driven him insane and “he never regained his reason,” according to an article in the New York Times. The child was taken to the New Jersey State Hospital for the Insane for an indefinite stay.

1849 Asylum Report

Three years after that, Daniel’s wife was killed on the railroad (details unspecified). His wife’s death, combined with his son’s tragic circumstances, drove the widower insane. He, too, was committed to the New Jersey State Hospital for the Insane. Father and son remained there for more than twenty years. Daniel Henry died at the asylum in September, 1907 at the age of 75. His son remained, with little chance of recovery.

State Asylum at Trenton Baseball Team, courtesy New Jersey State Library

No details were given about whether or not the two were capable of recognizing and interacting with each other, but if they could, perhaps they were each able to take comfort in the other’s presence.

For A Price

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Dr. Boris Sidis

“A good many people are beginning to realize that nervous diseases are alarmingly on the increase …. Nerves are the most ‘prominent’ complaint of the 19th century,” wrote one reporter in an 1887 issue of the Boston Globe.

As always, medical entrepreneurs found ways to accommodate the trend to everyone’s satisfaction. When a case of “nerves” became unbearable to a person or unmanageable for the family, alienists found a way to cater to wealthy patients’ need for privacy and luxury. The Sidis Psychotherapeutic Institute was an example: it was a private asylum containing “beautiful grounds, private parks, rare trees, greenhouses, sun parlors, palatial rooms, luxuriously furnished private baths, private farm products,” according to a brochure designed to appeal to Professor Boris Sidis’ expected clientele.

Images From the Sidis Psychotherapeutic Institute

Sidis also had a reassuring message for them. “It is well known and correspondingly deplored among physicians and psychologists,” Dr. Sidis explained, “that there are fully 50pc. of mentally disturbed cases that cannot be cared for in an insane asylum. These cases are of persons who are not actually insane, but who are on the verge of that condition. Also, they are not physically ill, or if they are ill it is not so serious that they should be sent to a hospital.”

McLean Asylum for the Insane Began as a Mansion Purchased from Joseph Barrell

McLean Asylum for the Insane in Charlestown, Massachusetts Began as a Mansion Purchased from Joseph Barrell

For families wishing to avoid the stigma of insanity, a private “institute” or sanitarium was far preferable to a crowded state-run asylum manned by poorly paid and trained staff. These private asylums probably gave patients–many of whom undoubtedly had genuine mental illness–the relief they needed and served the purpose for which they were created. However, they came with a price most of the country couldn’t afford. Sidis charged today’s equivalent of $1,000 a week–out of reach for all but the wealthy. No matter how desperate they might have been to put their loved one in the best place possible, most families had to settle for state asylums.

Unhappily Ever After

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Charles Dickens Tried to Have His Wife Committed to an Asylum During His Affair With a Young Actress, photo circca 1850 of the Charles, Catherine, and Two of Their Children

Charles Dickens Tried to Have His Wife Committed to an Asylum During His Affair With a Young Actress, photo circa 1850 of Charles, His Wife, and Two of Their Children, courtesy Smithsonian Magazine

Most families hesitated to commit their loved ones to insane asylums until they became violent, uncontrollable, physically ill, or burdened with conditions that required constant care (hallucinations, suicidal tendencies, etc.). Unfortunately, men sometimes sent the inconvenient women in their lives to asylums, and married women were especially vulnerable.

In 1882, Mrs. Martha J. Collins suspected her husband of infidelity, and when she actually gained proof of it, he retaliated by sending her to the Kings County Lunatic Asylum in NY, and later, to Bloomingdale Asylum. Doctors released her as sane almost immediately from each institution, but her husband pressed on and sent her to the Buffalo State Asylum for the Insane. After five weeks, she managed to get a letter delivered to her legal counsel.

Buffalo State Asylum for the Insane

Mrs. Collins’ attorneys argued that she had been committed illegally, and the asylum’s authorities considered her sane enough to be released into the care of her husband. After discussion (probably rather heated on her part) Judge Smith of the Superior Court released her unconditionally. When her husband approached her, she said, “Mr. Collins, I will shake hands with you: but that is all,” and refused to return home with him unless he agreed not to imprison her again.

A Desperate Elizabeth Packard Tries to Change Her Husband’s Mind About Committing Her to Jacksonville State Hospital in Illinois

Refusing to return home was a courageous step for a woman of that time, who likely had little money of her own or any way of earning a living. She did keep a diary about her asylum experiences, and planned to have it printed. Hopefully, the publicity protected her from any further bullying by her husband.

Medical Conditions and Insanity

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John Taylor, Who Was Committed to Lancaster County Asylum (UK) in 1901 for General Paresis of the Insane

Physical conditions like epilepsy sometimes brought their victims a diagnosis of insanity because of the behaviors these conditions manifested. Other diseases and physical problems were likewise misdiagnosed and forced victims into insane asylums rather than more appropriate hospital treatment. A man described in the October 15, 1870 issue of the British Medical Journal was probably typical. He had been admitted after paranoia and hallucinations made it impossible for him to care for himself. He was only 35 at the time of admission, but had “led an irregular life” for many years prior.

“He said he underwent nightly a kind of torture,which he called the “cylinder finish”, and which he described as an excruciating process, by which his brains were whirled round with extreme velocity, mixed into a pulp, and replaced in his skull just in time for his awaking. This, he believed, was ordered by the doctor, who knew of everything that was done to him, and had the power of regulating the amount of his sufferings,” wrote Dr. H. Grainger Stewart. Commitment to an asylum for a patient like this seemed to make perfect sense.

Al Capone Was Released From Prison in 1939 After a Diagnosis of Syphilis of the Brain

Alienists knew there was little they could do for patients with this form of insanity, called general paralysis of the insane (GPI), beyond giving them sedatives to help them sleep. And sadly, by the time these extreme symptoms manifested, patients often did not have long to live.

Much of Syphilitic Insanity Could Have Been Prevented With Prompt Treatment for the Initiating Disease

Physicians were able to make a tentative link between GPI and previous exposure to syphilis, but weren’t certain because syphilitic insanity did not respond to treatment with mercury the way syphilis did. However, when the bacterium that caused syphilis was discovered in 1905, a test was developed shortly thereafter to detect its presence. Doctors finally realized that untreated syphilis was the cause of the deteriorating mental condition known as general paralysis (or paresis) of the insane.

Comparing Insanity Rates

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Black Patients Received Less Funding for Mental Health Care, Montevue Asylum in Maryland, circa 1909

Alienists knew that the rates of insanity for various races differed, and came up with several explanations for it. One particularly condescending theory about the lower rates of insanity found in Native Americans and blacks was that these races didn’t face the responsibilities and pressures that so-called “civilized” races did. Especially for blacks, so long as they remained slaves and had most decisions made for them, the theory went, they were relatively untroubled by insanity. With freedom and its burdens, however, came overwhelmed minds that led to mental breakdown.

In 1914 Dr. Mary O’Malley at St. Elizabeths’ (Government Hospital for the Insane) compared rates of white and black insanity. What she found initially fit right in with the “civilization” theory: In 1860 during slavery, “one in every 5263 colored persons were insane . . . and in 1910 there was one in every 723 colored persons insane.” O’Malley noted that between 1860 and 1910, insanity in the “colored population” had increased 1,670 per cent.

However, when she studied black and white female* patients–an important distinction–at St. Elizabeths, her results were much less skewed. During the previous four years, 345 black and 455 white women had been admitted. Rates of specific mental conditions proved interesting:

Dr. Mary O’Malley in Center Photograph, photo courtesy of Flickr, taken from History of the Medical Society of the District of Columbia, 1817-1909

Dementia praecox: (black) 37%; (white) 37%

Organic brain disease: (black) 16%; (white)13%

Undifferentiated psychoses (black) 6%; (white) 4%

Manic-depressive: (black) 9%; (white) (11%)

Diversional Occupation at Central Lunatic Asylum in Virginia, the Country’s First Institution for Colored Persons of Unsound Mind

Rates for other diagnoses were similarly close. One distinction that O’Malley did find was that black patients had much lower rates of melancholia and suicidal tendencies. This was especially surprising considering the rates of poverty and lack of status for blacks during this time period.

*Because these women were not veterans as most of St. Elizabeths’ male patients would be–and thus coming from widely differing backgrounds and from many birthplaces–they represented a fairly even-matched pool of impoverished women in the Washington, DC area.

Debating Restraints

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Illustration Showing a Black Man Sitting in a Chair Wearing a Straitjacket, courtesy National Library of Medicine

When British physician Dr. John Bucknill visited U.S. insane asylums and wrote an article about his observations for the October, 1876 edition of the American Journal of Insanity (see last post), he discussed the issue of restraining patients. British asylums had done away with restraints almost entirely, and Bucknill did not like to see them used as freely in the U.S. as he saw during his visits. In his discussion about their use in America, he made the following observations:

Dr. Green of the Georgia State Asylum said that he did not like to use restraints, but did with four classes of patients. These were: suicidal patients, persons who will not remain in bed, persons who persistently denude themselves of all clothing, and inveterate masturbators.

Bucknill also mentioned that Dr. Ranney, who prided McLean Asylum with bringing its use of restraints down to a very low level, still used mechanical restraints on the following types of patients: those exhibiting acute mania; patients who wound themselves, creating ulcers that would never heal themselves unless their hands were confined; epileptic patients who so often became violent; persons whose feelings are greatly perverted and prone to see insults or evidence of conspiracy, who were sometimes little less ferocious than wild beasts; and persons in the throes of acute delirious mania.

McLean Asylum, courtesy Boston Public Library, Digital Commonwealth

“It will be observed,” said Dr. Bucknill, “that . . . we already have nine classes of lunatics who need mechanical restraint, in America.” He added that Dr. Slusser of the Ohio Hospital for the Insane added another class: “. . . those who persistently walk or stand, until their extremities become swollen, and they give evident signs of physical prostration. I have no way of controlling such, but by tying them down on a seat.”

This addition made ten classes of patients needing restraint, but Dr. Bucknill continued with a list of other reasons doctors restrained their patients until he named “fourteen classes of the insane altogether who absolutely need mechanical restraint in the State Asylums of America.” Bucknill noted some ways that British asylums found to avoid restraints, but realized that the American mindset was simply different on this issue.

Mock-up of a Patient in a Restraining Device Called a Utica Crib

Bucknill did say, “Is it surprising that, at the present time, the management of asylums for the insane in America is the subject of mistrust with the people?”

A Room of One’s Own

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Blockley Alsmhouse

Few patients in mental institutions were so out of touch with reality that their surroundings made no difference to them. One of the pillars of early psychiatric theory was that a patient’s environment did, indeed, made a great deal of difference. This is a particular reason alienists recommended bringing patients out of their old home environments and into the insane asylum’s new one. The implication, of course, was that the asylum’s was better. Most planners did strive to provide stately, serene buildings within a pastoral country setting. The reality did not always match their hopes.

The October, 1876 issue of the American Journal of Insanity included an article by Dr. John Bucknill, “Notes on Asylums for the Insane in America.” In it, Dr. Bucknill pointed out some glaring deficiencies within Philadelphia and New York asylums.

Dr. John Bucknill

In Philadelphia, a collection of buildings called the Blockley Almshouses, included an insane asylum. The place was constructed to hold 500 patients, and instead held 1,130. Beds were strewn on any available floor space at night to accommodate the extra people, and consequently the air become humid and smelly. Dr. Bucknill noted that there was nowhere for patients to exercise.

The female ward was particularly shameful. In a space designed to accommodate 19 “excited patients” in single rooms, instead held 65 women. The rooms were only six feet by 10 feet to begin with, which was justified by their use to for manic or disturbed patients. Unfortunately, Dr. Bucknill wrote, “. . . these lodging rooms are occupied at night generally by two, and frequently by three persons, and all of them, as I was informed, were regularly put into strait-jackets to prevent mischief during the night.”

Woman Wearing a Strait Jacket in Bed, 1889

How anyone–staff, trustees, inspectors–could have seen this situation and expected patients to recover their sanity says a great deal about the people running it. Dr. Isaac Ray, in an 1873 paper read before the Social Science Association of Philadelphia, said of the conditions: “If homicide is not committed every night of the year, it is certainly not for lack of fitting occasion and opportunity.”

Healing, Hell, and the History of American Insane Asylums

The History of Insane Asylums

Category Archives: Patients

Real Friends

Why Asylums?

Nerve-Waste and Insanity

Strong Ties

For A Price

Unhappily Ever After

Medical Conditions and Insanity

Comparing Insanity Rates

Debating Restraints

A Room of One’s Own